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Facial Plast Surg 2016; 32(04): 351-360
DOI: 10.1055/s-0036-1585423
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Septal Surgery Challenges in Rhinoplasty

Fazil Apaydin
1   Department of Otorhinolaryngology, Ege University Medical Faculty, Bornova, İzmir, Turkey
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Publication History

Publication Date:
05 August 2016 (online)

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Abstract

During rhinoplasty, the most stressful areas of the nasal cartilaginous septum are at the key area and anterior nasal spine. A stable fixation of the caudal septum to respond to these stresses is of utmost importance. The prerequisite for a successful fixation is a well-prepared recipient bed for caudal septum and suture fixation. The bed can be opened by using scissors, osteotome, or powered instrumentation. Simple or multiple sutures passing from the bone and/or surrounding soft tissues are used for fixation. At the key area, if a complete separation of the L-strut occurs, it should be sutured to nasal bones and upper lateral cartilages. The septum should be supported by splinting spreader grafts to increase stability. To prevent dorsal irregularities, a dorsal onlay camouflage graft should be used. The best way is to take cautions to prevent such a mishap. That is why a dorsal segment of 12 to 15 mm should be preserved, at least at the key area, and part of the mucoperichondrium should stay attached to the septum.

Keywords

septoplasty - rhinoplasty - key area - separation of the L-strut - subluxation - caudal septum - spreader grafts

Note

This work was done at the Department of Otorhinolaryngology, Ege University Medical Faculty, Bornova, İzmir, Turkey